On-line version ISSN 2078-5135Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.99 n.5 Cape Town May. 2009

Mao Tse-tung (Mao Zedong) was born of Chinese peasant stock in the twilight years of China's imperial reign, which had lasted for more than 2 000 years. He lived to become paramount ruler over a quarter of the global population, and to establish the world's largest Communist regime. His successes as revolutionary leader were, however, not matched by a comparable ability to develop and administer his new nation. Nathan1 states that no other leader in modern history held so much power over so many people for so long, and in the end inflicted such a catastrophe on his country, as Mao did. It is estimated that he was responsible for the death of more than 70 million Chinese in peacetime.2 This study concentrates on Mao Tse-tung as a person, and his habits and health problems.

Life story

His youth

Mao Tse-tung was born on 26 December 1893 in the Shaoshan Valley, Hunan province, where his ancestors had lived for at least 500 years. His father was a relatively well-off property-owning peasant. Mao maintained a lifelong regard for his mother, but gradually rebelled against his father, who tried to force him into a peasant life  a mode of existence that he disliked. He received a good schooling before leaving the valley permanently at the age of 18 (in 1911) for teacher training in the provincial capital, Changsa. At the age of 14, his parents betrothed him, according to local custom (but against his will), to one Miss Luo, but the marriage was not consummated.2

His years in Changsa, where he obtained a teacher's qualification in 1918, were eventful. The resignation of the last Chinese emperor in 1911, and the subsequent establishment of the Republic of China, put the country into turmoil. Mao temporarily joined a rebel Hunan army, but then returned to his studies. He read widely, became familiar with Eastern as well as Western literature, and broke permanently with Confucianism. The 1917 Bolshevik Revolution in Russia stimulated an interest in socialism and Marxism, and he founded a radical socialist student movement. In 1916, the Republic of China dissolved, and a decade of decentralised anarchy (Era of the Warlords) followed. Sun Yat-sen, heading the Gusmindang (GMD) movement, formed a temporary government, which at this stage also had to defend China against an invading Japanese army.3

The young Communist

In 1920, Mao Tse-tung married Yang Kaihui; the marriage lasted 8 years, and produced 3 children before Mao divorced her in 1928.4 Very impressed with Russian Bolshevism, he founded a Communist Youth League, and in 1921 was a founder member of the Chinese Communist Party (CCP) in Shanghai. In the meantime, Sun Yat-sen's GMD had liaised with the Comintern in Moscow to become a socialist revolutionary movement, which now also co-operated with the young CCP. The early CCP structures were constantly battling local warlords. After Sun Yat-sen's death in 1925, Chiang Kai-shek took over the leadership of the GMD and immediately established it as the leading military power in China by virtually destroying the northern warlords. In 1927, from Canton, he unexpectedly launched a vicious attack (the White Terror) against Chinese Communists. The CCP, in particular, was almost annihilated. Mao and the embryo of the later Red Army (3 500 men) escaped to the mountainous strongholds of Jiangxi province. In this relatively sympathetic rural community, he proceeded to establish a communist republic (soviet). Here he was also called Chairman Mao for the first time; he soon headed an army of 40 000 men.3 In 1928, he married his second wife, He Zichen, an 18-year-old revolutionary compatriot. The marriage lasted 10 years and there were 5 children.4

The Great March and its aftermath

Mao's ruthless suppression of all opposition and his autocratic actions in the Jiangxi Soviet raised alarm within the wider CCP, which soon intervened, with the support of the Russian Comintern. Mao was demoted and replaced by the so-called '28 Bolsheviks' from Moscow. Military attacks by Chiang Kai-shek's GMD slackened as a result of a Japanese invasion in 1932, but 2 years later it became clear that a massive GMD onslaught was imminent. The CCP decided to evacuate the Jiangxi Soviet and, in October 1934, the so-called Great March over 10 000 km towards friendlier communities in northern China commenced. At the onset, Mao was ill, in disfavour and a relatively junior member of the ruling politburo. However, he soon showed his mettle as a military leader by outmanoeuvring the opposition and, by the time the Great March terminated in Sichuan province, 9 months later, he had become the movement's undisputed leader. Although Mao later mythologised the Great March, it was in reality a temporary military defeat for the CCP. Constantly harassing the Red Army with overwhelming GMD forces, Chiang Kai-shek, for strategic reasons of his own, refrained from launching a decisive attack. In one battle alone (a 5-day engagement at the Chiang River), the CCP lost half of its army of 60 000 soldiers. At one stage, Mao turned down the sympathetic support offered by another army of 80 000 men, since he feared that the general, with his larger army, would replace him as commander-in-chief. For Mao, personal advantage clearly counted more than the interests of his army.5,6

From his new headquarters in Yanan, Sichuan province, Mao, as undisputed leader of Chinese Communism, now proceeded to consolidate his position. His army rapidly grew to 50 000 men. Periodic attacks by the GMD were repulsed and, when Japan escalated its invasion of China in 1937, the threat from Chiang Kai-shek largely receded. The GMD's subsequent ineffective resistance against Japan benefited Mao morally. Moscow now forced an unenthusiastic Chiang Kai-shek into an uneasy military coalition with the CCP, which lasted through World War II (1939 - 1945). Mao's style of communism gradually deviated from standard Marxism, which irritated Moscow, who considered Mao an underling of Soviet Communism. Mao had indeed become a cult figure in Communist China.6

In 1938, he divorced his second wife and married an actress, Jiang Qing, who would later become a controversial political figure.4 The end of World War II also heralded the end of the strained pact between Chiang Kai-shek and Mao, and precipitated the outbreak of civil war in 1945. Initially vastly outnumbered, the CCP armies marshalled increasing popular support, and gradually gained the upper hand. When Beijing fell, Chiang Kai-shek permanently left mainland China for Taiwan in September 1949. On 1 October 1949, Mao announced the founding of the People's Republic of China (PRC) from the South Gate of Tiananmen Square, Beijing, in the presence of 300 000 cheering supporters.7

The People's Republic of China

One of Mao's first actions as chairman of the PRC was to lead a 3-month-long state visit to Moscow, beginning in December 1949. This was his first visit outside China. Stalin treated Mao as his inferior and negotiations were tense, predominantly favouring the Russians. The Korean War (1950 - 1953), which broke out soon afterwards, was probably engineered by Stalin, but support for North Korea came solely from China, with half a million Chinese soldiers dying in the conflict.7,8

In 1951, Mao started a merciless campaign against corruption, but also against all political opposition; the media were placed under strict supervision and all religions were banned. In 1952, a Five-Year Plan, based on collectivisation and industrial development, was launched, with central control over all social and cultural activities. 'Reactionary elements' were prosecuted mercilessly, executed or sent to special work camps. By 1955, 100 000 CCP members had thus been eliminated. In his One Hundred Flowers Campaign (1956 - 1957), Mao asked for honest comment from the populace on his government's recent policy projects. The response, however, upset him to such an extent that the immediate prosecution of all 'rightist elements' was ordered  half a million party members were banished to labour camps. By this time, Stalin had died and Khrushchev's outright condemnation of 'Stalinism' (1956) greatly upset Mao, who feared a political backlash against himself, but this did not happen.7,8

In 1957, Mao launched his Great Step Forward, through which he attempted in a quite unrealistic (but potentially magnificent) way to rapidly promote Chinese development and bring it in line with that of the West. The result was industrial and economic disaster and the collapse of agriculture. A famine followed, which lasted 4 years and caused the death of 50 million Chinese. Communication with the Soviet Union was resumed, but proved disastrous. In 1961, diplomatic relations were severed and open animosity erupted between the two communistic countries. Partly as a result of the famine, Mao resigned as chairman of the CCP (1958) and scaled down his political activities. However, in no way did this diminish the high national esteem he was held in, and his Little Red Book (Thoughts of Chairman Mao) became a standard text.7

The Cultural Revolution, launched in 1965, was primarily aimed at the elimination of all opposition to Mao and to the Party. A Cultural Revolution Committee was appointed to ensure the eradication of 'four old things': old ideas, old culture, old habits and old customs. Mao's wife, Jiang Qing, and her infamous Gang of Four, played a major role in the persecution of the Chinese populace. Radicalised youths were mobilised as Red Guards to destroy all offending things, systems and cultures  for the good of the great revolution. By 1970, the national disruption had become so extensive that Mao personally ordered the Red Army to restore order. Eventually, it took decades to undo the enormous damage inflicted on education, training, science and technology.7

Partly as a snub to Moscow, Mao invited Richard Nixon, president of the USA, to visit him in 1972. During this visit, it became evident that Mao was unwell; the last years of his life brought progressive ill health, but the Chinese nation was not informed about his deteriorating condition. In early 1976, he appointed the relatively unknown Hua Ghuo-feng as his successor, and in February he invited Nixon to visit him again. Mao died on 9 September 1976, at the age of 83  half-blind, totally paralysed, deaf, dumb and unable to swallow, but mentally clear.7,9 His body lay in state in the Great Hall of the Nation for a week. A memorial ceremony followed at the South Gate, Tiananmen Square, Beijing, on 18 September. His embalmed body was placed in a sarcophagus in the Chairman Mao Memorial Hall, Tiananmen Square.10,11

Habits and health

Today, it is evident that the popular image of Mao as a kind, sympathetic philosopher-ruler, which was propagated during his life (and to a lesser extent in present-day China), was and is misleading. Mao was indeed quite merciless and ruthless in acquiring and maintaining his undisputed position of leadership.1 He also strictly prohibited dissemination of information about his health;9 this eventually became known only when individuals such as Zhisui Li (his personal physician for 22 years) recently published their memoirs.1 Mao was a product of his time, i.e. of the early 20th century when Imperial China gave way to a Communist state by way of a chaotic transition in which authority was gained and maintained through the barrel of a gun.

Measured by Western standards, Mao maintained poor personal hygiene. He liked swimming but never bathed; he preferred to rub himself down periodically with a warm towel. He did not brush his teeth, but rinsed his mouth daily with tea. He refused all dental therapy and consequently had chronic dental problems. By 1970, he had lost all his upper teeth. He preferred fatty foods, and was a heavy cigarette smoker; he did not consume alcohol regularly but, in 1933, during a period of depression, he drank heavily.5 He slept on a large wooden bed with a firm mattress; the bed accompanied him on his travels  even to Moscow.1,11 He was regularly plagued by body lice.4 He had an unhealthy skin and, in 1963, maltreatment of a chest pustule led to the development of a life-threatening abscess and septicaemia.11

Mao had 4 wives (although the first marriage when he was 14 was not consummated) and at least 9 children.4 He had countless mistresses and, like Chinese emperors of antiquity, believed that regular sex ensured a long life. As the established national leader, mistresses were supplied according to his wishes; during the chaos of the Cultural Revolution, he enjoyed 3 to 5 women simultaneously in his bed. Even when he had become incapable of sexual relations, he insisted on having young women around him. Although he was not blatantly bisexual, it is recorded that attractive young men were occasionally invited to satisfy him sexually. He had an undescended right testicle, suffered from various venereal diseases (including gonorrhoea and genital herpes) and, by 1955, semen analysis showed him to be sterile. Fear of impotence, especially in times of stress, was a major worry.4,11

Mao's first recorded illness dates back to 1924 (when he was 31), when he was caught up in leadership squabbles in the young CCP and suffered from weight loss, insomnia and constipation. This was clearly a psychosomatic disorder, associated with stress, and it would harass him for the rest of his life. Zhisui Li, his personal physician, called it neurasthenia, and found that Mao responded to stress with a variety of symptoms which, in addition to insomnia and constipation, included dizziness, impotence, lack of appetite, itchy skin, depression and social withdrawal. Sleeplessness became part of Mao's unpredictable daily routine, which often included no sleep for 24 hours. He usually did not wear a watch, and expected others to adapt to his irregular habits; meetings (in his bedroom) after midnight became a regular occurrence. In 1925, Mao commenced barbiturate therapy for his insomnia. He gradually developed drug tolerance and late in life took vast doses as a barbiturate-dependent. From 1955, he also took chloral hydrate. Constipation became an obsession and, towards the end of his life, some newspapers even ran a regular report on Chairman Mao's stool habits.1,11

During his years in the Jiangxi Soviet, Mao experienced repeated attacks of malaria  particularly so in 1929 and in 1931 - 1934. In 1933, he was seriously ill with what was probably cerebral malaria. Quinine therapy was usually effective, but the disease often caused incapacitating weakness and weight loss. During the Great March, he was borne across the Snow Mountains on a stretcher because of malaria.3,5 In November and December 1945 (at the outbreak of the final civil war with Chiang Kai-shek), he became depressed and kept to his bed with symptoms of perspiration, trembling and involuntary spasms of his arms and legs; this could have been malaria, but was more probably a variant of his psychosomatic syndrome.5 He was very upset when Stalin commenced post-war negotiations with the GMD while ignoring him. During Mao's visit to Moscow in 1949, he also developed an episode of unexplained weakness, trembling and headaches, which could have been the result of his apprehension regarding the pending negotiations with Stalin.7

From adolescence, Mao experienced periodic colds and bronchitis.11 In 1932, he received treatment for tuberculosis in a clinic.3 In his 60s, Mao's attacks of bronchitis worsened and, in November 1970, he was seriously ill, with radiological evidence of pneumonia. This was the first time that Mao agreed to a radiological examination. With few exceptions, he was very sceptical of doctors and their therapies. In 1971, Mao again went down with severe respiratory infection and possible early heart failure. He initially refused all therapy, but then worsened rapidly, developed an episode of loss of consciousness, and eventually agreed to extensive special examinations. These showed congestive cardiac failure, ventricular extra-systoles and ECG evidence of coronary disease. Chest radiographs showed prominent emphysema.11,12 Mao therefore had a typical history of chronic obstructive airways disease leading to emphysema and right-sided heart failure (cor pulmonale). His smoking habits and previous pulmonary tuberculosis would have been aggravating factors. He stopped smoking in 1973. Associated ischaemic heart disease and hypertension further impeded his cardiac function; in 1976, there was ECG evidence of myocardial infarction.7,12

During the last 4 years of his life, Mao realised that he was losing his grip on national affairs, becoming progressively more paranoid and irritable, and suffered from a speech defect, progressive muscle weakness, deafness and blindness.7 The latter was due to bilateral cataracts, but only in July 1975 did he agree to a limited right-sided cataract removal. With the aid of a pair of glasses, he now had a limited ability to read. He died before the left cataract could be removed.7,9 The cause of his deafness remains unknown.

In 1974, amyotrophic lateral sclerosis (motor neuron disease) was diagnosed as the cause of his muscle weakness, speech impairment and difficulty with swallowing. Gradually, this incurable disease caused complete immobilisation and necessitated feeding through a naso-gastric tube and permanent use of a respirator;7,9 the latter was a gift from Nixon. The true nature of the disease was never explained to Mao, and not made known to the Chinese nation. Up to the end, Mao was fed and regularly sponged down by two young dancers, dressed as nurses.11 Interestingly enough, when Mao was told of the death of Chiang Kai-shek in April 1975, he arranged a day of private mourning for his erstwhile opponent.9 Mao's treatment was overseen by a team of 16 doctors and 24 nurses but, in a bizarre way, admission to the patient was controlled by one Zang Yu-feng, an earlier mistress and secretary of Mao. Part of her task was to manage and contain politically motivated interference by his wife, Jiang Qing.4,11 His death was precipitated on 9 September 1976 by a myocardial infarction. Mao was mentally clear up to the end.12

Conclusion

In terms of communist ideology and world-view, Mao Tse-tung was an excellent revolutionary; but he was not a good administrator. He successfully consolidated the world's largest communist state (and the country with the largest population), ruling over about a quarter of the world's total population. Over time, he became a ruthless tyrant, responsible for the death of more than 70 million of his people, undoing much of his previous successes.

Mao could be casual, sympathetic and even charming, but his enormous reserves of anger, malevolence and contempt sometimes manifested in the ruthless destruction of opponents. He was a relatively healthy person, and only during the last decade of his controversial life did illness severely affect him. His various illnesses, however, did not necessarily influence his actions. One could rather say that his actions, as well as events in his country and in the wider world, in due course led to him developing a number of psychosomatic symptoms.

Francois Retief is a Rhodes Scholar, founder dean of the medical school at the University of the Free State, founder rector of MEDUNSA, and former secretary-general of the Department of Health; he retired as rector of the University of the Free State and is now a research fellow in the Department of English and Classical Culture at that university. Co-author André Wessels is a professor in the Department of History at the same university. *Corresponding author: A Wessels (wesselsa.hum@ufs.ac.za)